Department of Hepatobiliary Pancreas and Transplant Surgery, Kyoto University, Kyoto, Japan.
Advanced Institute of Liver & Biliary Sciences, Fortis Hospitals, Delhi, NCR, India.
Int J Surg. 2020 Oct;82S:128-133. doi: 10.1016/j.ijsu.2020.06.022. Epub 2020 Jun 30.
A dilemma of graft selection between right or left livers occurs during the planning of living-donor liver transplantation (LDLT) as well as splitting a whole liver graft into full right/full left grafts in deceased-donor liver transplantation. The right liver's relation to the whole liver could be considered as the trunk of a tree; it has a larger volume, the main axis of bile ducts, and the inferior vena cava mainly belongs to the right liver. Therefore, it was considered as the standard graft in LDLTs. Whether to procure the middle hepatic vein (MHV) with a right liver graft or to leave it attached to the left-liver remnant largely depends on the transplant institute. Recently, most transplant institutes tend to leave the MHV with the left liver for the sake of donor safety. Unlike hepatectomy for liver tumors, it is vital to preserve inflow and outflow for both the resected as well as the remaining livers. While procuring any graft type, the most important is to procure a liver graft with reconstructable portal veins, hepatic arteries, hepatic veins, and bile ducts, which should be well preoperatively planned using 3D-computed tomography with considerations given to graft volume and potential congestion areas.
在活体肝移植（LDLT）规划以及在尸体供肝肝移植中将整个肝脏分为全右/全左移植物时，会出现右肝或左肝供肝选择的困境。右肝与整个肝脏的关系可以被认为是树干；它具有更大的体积、主要的胆管轴和下腔静脉主要属于右肝。因此，它被认为是 LDLT 的标准移植物。是否从右肝中获取中肝静脉（MHV）或让其与左肝残端相连，在很大程度上取决于移植机构。最近，大多数移植机构倾向于将 MHV 留在左肝，以确保供者安全。与肝肿瘤切除术不同，为了保证切除肝和剩余肝的流入和流出，这一点至关重要。在获取任何类型的移植物时，最重要的是获取门静脉、肝动脉、肝静脉和胆管可重建的肝移植物，这应使用 3D 计算机断层扫描进行术前规划，并考虑移植物体积和潜在充血区域。
